Healthcare Provider Details

I. General information

NPI: 1801024773
Provider Name (Legal Business Name): HAINES CITY HMA URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 CYPRESS GARDENS BLVD
WINTER HAVEN FL
33884-3246
US

IV. Provider business mailing address

5811 PELICAN BAY BLVD SUITE 500
NAPLES FL
34108-2704
US

V. Phone/Fax

Practice location:
  • Phone: 239-598-3131
  • Fax:
Mailing address:
  • Phone: 239-598-3131
  • Fax: 239-598-9433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. STANLEY D MCLEMORE
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 239-598-3131